Migraine

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Introduction

migraine is a chronic neurological disorder that is mostly characterized by severe headaches and aura. Headache is called migraine if it meets four out of the following five criteria: Pulsating (the headache is pulsating or throbbing) One day (the headache lasts one day, actually between 4 and 72 hours) Unilateral (the headache is only on one side of the brain) Nauseating (the headache is accompanied by nausea or vomiting) Dibilitating (the headache precludes normal function/daily activities) There are many parallels between pain and migraine and therefore many of the literature discussion for pain also holds true for migraine. This section deals with the literature that is specific to migraine.

Please note that, while based on preclinical and/or clinical research, this prescription advice is solely intended as a guideline to help physicians determine the right prescription. We intend to continuously update our prescription advice based on patient and/or expert feedback. If you have information that this prescription advice is inaccurate, incomplete or outdated please contact ushere.

The pain phase of migraine is mediated by and can be blocked through both CB1 and CB2 receptors (Greco et al., 2014).

Pre-administered Anandamide significantly reduced nociceptive behavior in rats, suggesting that migraine may actually be a manifestation of a dysfunctional endocannabinoid system (Greco et al., 2011), which in turn offers interesting possibilities for endo- and plant cannabinoids in the treatment of migraine.

Interestingly, blocking TRPV1 function has no effect but stimulating these receptors offers pain relief; in fact transient activation is followed by prolonged de-sensitization and thus effective pain relief.

TRPV1-mediated antinociception is thought to work in synergy with CB1-mediated neuronal inhibition in pain management (Hoffmann et al., 2012).

An important structure in pain processing is the ventrolateral periaqueductal grey (vlPAG).

In the vlPAG, pain processing depends on cross-talk between the endocannabinoid and serotonin signaling system (Akerman et al., 2013).

In one study, the effect of medical cannabis on migraine was tested. Without selecting for application route or dose, the use of medical cannabis highly significantly reduced the frequency of migraine headaches from 10.4 to 4.6 per month (p<0.0001)(Rhyne et al., 2016).

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